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Provider Application Processing FAQs

 1. How do applicants enroll to be Medi-Cal providers? To enroll as a Medi-Cal provider, the appropriate application package must be submitted for the appropriate provider type. For a listing of the required forms by provider type, please refer to the feature on the Provider Enrollment webpage Application Packages Alphabetical by Provider Type.

• To request an application form, please contact the fiscal intermediary, Xerox State Healthcare, LLC (Xerox), at their Telephone Service Center at (800) 541-5555.

OR

• Download application forms from the Application Forms by Form Name and Number of the Provider Enrollment page on the Medi-Cal Web site.

 

2. How do physicians who are new to Medi-Cal request to join an enrolled group? What forms are required?  Physicians who are new to Medi-Cal and are joining a Medi-Cal enrolled group must submit the Medi-Cal Rendering Provider Application/Disclosure Statement/Agreement for Physician/Allied/Dental Providers (DHCS 6216).  Providers who are enrolled in Medi-Cal with a current, active provider number (NPI) are not required to submit an application when joining Medi-Cal enrolled groups.

 

3. Who should an applicant contact to answer questions about completing the application? An applicant may contact the Telephone Service Center at
(800) 541-5555, the Provider Enrollment Message Center at (916) 323-1945 or submit written question(s) to the Department of Health Care Services, Provider Enrollment Division, MS 4704, P.O. Box 997412, Sacramento, CA 95899-7412 or via email at PEDcorr@dhcs.ca.gov.  DHCS can assist applicants by providing guidance on what forms to complete but DHCS staff may not provide advisory opinions regarding completion of applications.  DHCS is specifically prohibited by law from answering questions about interpreting the statutes or regulations and can only cite the statutes and regulations themselves.

To obtain information on the statutory and regulatory requirements for participation in the Medi-Cal program, please refer to the Statutes, Regulations, and Provider Bulletins section or the Application Packages Alphabetical by Provider Type section of the Provider Enrollment page. If unclear about how to interpret Medi-Cal instructions or regulations, please contact your legal counsel for assistance.  

 

4. What are the different address types, how are they used and how can they be changed? The application requests a business, a pay-to, and a mailing address. This information is used as follows:

• The business address is the physical location where services are being rendered. General correspondence will be mailed to this address. Post office or commercial boxes are not acceptable. A change in business address requires submission of a full application package, unless the provider is an individual physician and meets the criteria to use the shorter DHCS 9096 application form. The pay-to address is the address at which the provider wishes to receive payment for services. Post office or commercial boxes are acceptable. A change in the pay-to address can be made on a provider’s file by submitting all relevant information to Provider Enrollment Division on a Supplemental Changes Form (DHCS 6209).

• The mailing address is the address at which the provider wishes to receive the "Welcome To Medi-Cal" package, the assigned Provider Identification Number notification and any additional informational bulletins. Post office or commercial boxes are acceptable. A change in mailing address can be made on a provider’s file by submitting all relevant information to Provider Enrollment Division on a Supplemental Changes Form (DHCS 6209).

 

5. How does a non-profit entity complete the Medi-Cal Disclosure Statement (DHCS 6207)? Most non-profit organizations are run by a governing board (e.g., Board of Directors). As such, each member of the applicable governing board must be reported.  Additionally, although the vast majority of non-profit organizations do not have owners, any individual who owns at least five percent of the non-profit organization must be reported.

 

6. Who can sign the application? The application must be signed under penalty of perjury by an individual who is the sole proprietor, partner, corporate officer or an official representative of a governmental entity or non-profit organization, and who has the authority to legally bind the applicant seeking enrollment as a Medi-Cal provider. Applications must have original signatures.

• Stamped, faxed or copied signatures are not acceptable.

• A photocopy of the application may be submitted, but it must have an original signature.

• It is unlawful to alter a photocopied application form in any manner.

• A biller or office manager is not a valid signatory.

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7. Where do applicants mail the application? 

Completed forms should be mailed to:

Department of Health Care Services

Provider Enrollment Division

MS 4704

P. O. Box 997412

Sacramento, CA 95899-7412
 

Please note that some of the applications and forms may show this address with a P.O. Box and Zip Code ending with the number three instead of two. Both addresses are current and valid addresses for submission of applications, forms and correspondence, but the address shown above will eventually be published on all documents for submission to the Provider Enrollment Division. 

NOTE: Provider Enrollment staff cannot meet with individual applicants. An application cannot be delivered in person to the DHCS.

 

8. How long does it take to process the application? Applications are reviewed and processed in accordance with Medi-Cal provider enrollment statutes and regulations. The review of an applicant’s or provider’s application package is a complex process that requires assessment of many elements of the application, including a review of the required supporting documentation, to determine eligibility for enrollment into the Medi-Cal program. DHCS may conduct a background check of an applicant or provider for the purpose of verifying information. This background check may include an unannounced onsite inspection, a review of business records and data searches to ensure that the applicant or provider meets enrollment criteria.

Effective July 1, 2008, DHCS provides an "acknowledgment of receipt letter" for an application package from a physician or a physician group within 15 days. For applications from provider types other than physicians or physician groups, a written notice confirming receipt is mailed within 30 days. This letter also may notify applicants whether a moratorium exists on their provider type.

Effective July 1, 2008, physician and physician group applicants are notified in writing of one of the four actions listed below, within 90 days of receipt of an application. Notification of DHCS action to applicants other than a physician or physician group remains at 180 days.

• The application is approved for enrollment as a provisional provider;

• The application is incomplete and additional information is required;

• The application is referred for a comprehensive review and background check; or

• The application is denied with the reason(s) for denial.

Effective July 1, 2008, "Preferred" provider applications are statutorily required to be processed in 60 days if all the required documentation is submitted. If all appropriate documentation is not submitted, the application may take up to 90 days to process. For information regarding the criteria for "preferred provider status" on our Web site, refer to the Medi-Cal Provider Enrollment Preferred Provider Status article, available on the Provider Enrollment page.

Effective July 1, 2008, DHCS notifies a physician applicant within 15 days of receipt of a Medi-Cal Hospital-Based Physician Application/Disclosure Statement/Agreement (DHCS 9095). Within 90 days, DHCS notifies the applicant of approval or notifies the applicant that the applicant does not meet the required criteria. For more information on the criteria, refer to the AB 1226 – Provider Enrollment Forms & Provisions Effective July 1, 2008 bulletin on the Medi-Cal Web site.

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9. What happens if applicants submit an incomplete application? Incomplete applications will be returned to the applicant with an explanation of what information is missing, and a request that these items be submitted within the 60-day statutory requirement.

• If a corrected application is returned to DHCS within 60 days of the notice, processing continues.

• If an application is not returned within the 60-day timeframe, then the late resubmitted application is treated as a new application and the application processing timeframe starts over again.

• Within 60 days after receipt of a timely resubmitted application, DHCS notifies applicants/providers of either approved enrollment, referral for a more comprehensive review or denial of enrollment.

 

10. Can applicants check the status of their application? If applicants do not receive an "acknowledgement of receipt letter" from DHCS within the timeframe specified in FAQ #8 above, they may contact the Provider Enrollment Message Center, (916) 323-1945, or submit their inquiry, in writing, via e-mail to PEDCorr@dhcs.ca.gov or to the address listed below:

Department of Health Care Services

Provider Enrollment Division

MS 4704

P. O. Box 997412

Sacramento, CA 95899-7412

In order to conduct research efficiently, please include the provider’s name and professional license number, social security number and/or tax identification number. If checking on the status of an application and you have received an acknowledgment of receipt letter, please also include in your written request a copy of the acknowledgement of receipt letter from the Provider Enrollment Division showing the six-digit document number assigned to the application. Also include this six-digit document number in any email status check requests.

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11. How are applicants notified of their application approval or disapproval?  When an application package is approved, providers receive a "Welcome To
Medi-Cal" letter and packet, which includes the effective date of enrollment for the approved service location. This approval letter and welcome package is sent to the provider’s mailing address from Xerox, the Medi-Cal fiscal intermediary.

When an application package is denied, applicants/providers are notified by letter from the Provider Enrollment Division, that the application package is denied. The specific reasons for the denial are listed in the notification letter.

 

12. What determines the effective date of a provider’s enrollment? The effective date of enrollment is the date a complete application is received by the Provider Enrollment Division, which is identified on a notice issued to the provider to acknowledge the application was received. For additional information on the specifics of effective date determination, please read the Medi-Cal Provider Enrollment Effective Date Determination provider bulletin, published in June 2004 .

 

13. Can an applicant or provider submit a photocopy or a faxed copy of the application package? A photocopy of the application package is acceptable; however, the signature on it must be an original. Stamped, faxed or copied signatures are not acceptable. Although the form may be photocopied, it is unlawful to alter it in any manner. If a mistake is made entering information on a form, line through the mistake and initial it. Do not use correction tape, white out, etc., to make corrections.